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Introduction: Hemodynamic instability during induction of anesthesia were reported in hypertensive patients who received ACE inhibitors. The modification of cardiac morphology, dynamic and hormonal changes were studied in hypertensive patients chronically treated with ACE inhibitor, perindopril, scheduled to receive general anesthesia.

Methods: With Institutional Ethics Committee approval. 28 hypertensive patients chronically treated perindopril underwent elective lower extremities surgery under general anesthesia were studied. Perindopril were continued until the morning of surgery. Patient was pre-medicated with midazolam. Anesthesia was induced with amidate, fentanyl and vacuronium. After tracheal intubation, anesthesia was maintained with fentanyl and sevoflurane in oxygen. Blood pressure determination, ultrasonography parameters recording (HP 1000) and hemodynamic variables were obtained prior to induction, post induction and when incision were made. Blood samples were obtained for radioimmuno assay of renin angiotensin system. Data were analyzed using two-way analysis of variance followed by Chi-square test. p<0.05 was considered the level of significance.

Results: The median age of patients was 51 yr. Cardiac morphology were unchanged as depicted by IVSd, LVPWd. and LVM. HR was unchanged, ABP were significantly reduced post-induction compared to pre-induction value and returned to pre-induction value as incision was made. Other results are presented in Table 1 and Table 2. Mean +/- SD. * P<0.05.

Conclusion: Early compromization on cardiac morphology during essential hypertension has been well established. Our study indicated that effects of perindopril during anesthesia were mild and left ventricular systolic function was well maintain which is independent of changes on blood pressure.